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Integrated Care Experiences and Outcomes in Germany, the Netherlands, and England

doctor patient health care

The Issue

To increase patient satisfaction, improve the efficiency of care delivery, and reduce costs, researchers and health care professionals have proposed integrated delivery networks for the care of patients with chronic diseases. Most integrated networks include a team-based approach, as well as an emphasis on patient participation. Commonwealth Fund–supported researchers evaluated three new integrated delivery networks in Germany, the Netherlands, and England.

What the Study Found


The German model saved $203 per patient per year and resulted in decreased mortality, higher patient satisfaction, and higher cooperation among care providers. The Dutch model saw an increased cost of $388 per patient per year, with mixed clinical outcomes but better experiences for patients and providers. England’s integrated care pilots, which saved from $93 to $358 per patient per year, resulted in mixed outcomes in terms of admissions (increased emergency admissions, although decreased elective and outpatient admissions), improved care planning, and enhanced cooperation among providers.


The German network model, the authors conclude, “deserves to be more closely studied by researchers and policymakers in the United States as they search for solutions to help accountable care organizations overcome the weaknesses of fragmentation, find appropriate financial incentives, and meet the needs of people with chronic conditions.”

Publication Details



R. Busse and J. Stahl, "Integrated Care Experiences and Outcomes in Germany, the Netherlands, and England," Health Affairs, Sept. 2014 33(9):1549–58.